Provider Demographics
NPI:1922336429
Name:SANDERSON, LAURI ELANA
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:ELANA
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURI
Other - Middle Name:ELANA
Other - Last Name:ENDICOTT/BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 E RIO VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2222
Mailing Address - Country:US
Mailing Address - Phone:360-853-2021
Mailing Address - Fax:
Practice Address - Street 1:203 E RIO VISTA AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-2222
Practice Address - Country:US
Practice Address - Phone:360-853-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)